YES = formulary NO = non-formulary NO BENEFIT = excluded. Beat4 Beat1 Beat 3 Pace2 Beat2 Pace1 Pace3 Pace4 A NO BENEFIT SANDOZ AMITRIPTYLINE 25
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1 Benefits are subject to the following: Pre-authorisation Bestmed guidelines Bestmed protocols Mediscor Reference Price (MRP) This price represents the reasonable price in the market place for a particular group of generic equivalent medicines which is reviewed and updated regularly. MRP sets a maximum reimbursable price for a list of generically similar medicines with a cost lower than that of the original medicine. There may be instances where a generic alternative costs more than the set MRP. If you opt to use the original medicine and a generic alternative is available, or you use a medicine that costs more than the MRP, you will have to pay the difference between the price of the chosen medicine and that of MRP. This formulary is effective from 1 January This formulary is subject to change without notice. ONLY the following medicine classes will be considered for Beat1 and Beat2: Atypical antipsychotics Butyropheonones Carboxamide derivative Selective serotonin re-uptake inhibitors (SSRI s) = formulary = non-formulary = excluded SCHIZOPHRENIA A AMITRIPTYLINE GULF AMITRIPTYLINE 25MG T SANDOZ AMITRIPTYLINE 25 TREPILINE 25MG TAB TRYPTAL 25MG TAB C CARBAMAZEPINE DEGRAL 200MG TAB SANDOZ CARBAMAZEPINE SANDOZ CARBAMAZE CR 200 SANDOZ CARBAMAZE CR 400 TEGRETOL 200MG TAB TEGRETOL CR 200MG TAB TEGRETOL CR 400MG TAB ZEPTOL 200MG TAB 1
2 CHLORPROMAZINE LARGACTIL 100MG TAB LARGACTIL 25MG TAB LARGACTIL 25MG/5ML SYR LARGACTIL 50MG TAB CITALOPRAM ARROW CITALOPRAM 20MG TAB AURO-CITALOPRAM 20MG TAB AUSTELL-CITALOPRAM 10MG AUSTELL-CITALOPRAM 20MG AUSTELL-CITALOPRAM 40MG BIO CITALOPRAM 20MG TAB CILATE 20MG TAB CILIFT 20MG TAB CILORAM 20MG TAB CIPRAMIL 20MG TAB CITALOHEXAL 20MG TAB CITALOPRAM ACTOR 20MG TAB CITALOPRAM-WINTHROP 20MG CITALOPRAM-WINTHROP 40MG DEPRAMIL 20MG TAB DEPRAMIL 40MG TAB DRL CITALOPRAM 20MG TAB DRL CITALOPRAM 40MG TAB GLENMARK CITALOPRAM 20M MERCK-CITALOPRAM 20MG RAN-CITALOPRAM 20MG TAB SANDOZ CITALOPRAM 20MG SIMAYLA CITALOPRAM 20MG TALOMIL 20MG TAB CLOMIPRAMINE ANAFRANIL 10MG TAB ANAFRANIL 25MG TAB ANAFRANIL SR 75MG TAB 2
3 CLOMIDEP 25MG EQUIRM 10MG EQUIRM 25MG CLOZAPINE ASPEN CLOZAPINE 25MG TAB CLOMENT 100MG TAB CLOMENT 25MG TAB CLOZAPINE-HEXAL 100MG TAB CLOZAPINE-HEXAL 25MG LEPONEX 100MG TAB LEPONEX 25MG TAB D DOTHIEPIN SANDOZ DOTHIEPIN 25MG CAP SANDOZ DOTHIEPIN 75MG TAB THADEN 25MG CAP THADEN 75MG TAB E ESCITALOPRAM ACCORD ESCITALOPRAM 10MG ACCORD ESCITALOPRAM 20MG ASPEN ESCITALOPRAM 10MG CIPRALEX 10MG TAB CIPRALEX 20MG TAB CITRAZ 10MG TAB CITRAZ 20MG TAB CITRAZ 5MG TAB DOLIN 10MG TAB DOLIN 20MG TAB ESCITALOPRAM 10MG BE-TAB ESCITALOPRAM 20MG BE-TAB ESCITALOPRAM WINTHROP 10 ESCITALOPRAM WINTHROP 20 3
4 ESCITALOPRAM WINTHROP 5 LEXAMIL 10MG TAB LEXAMIL 20MG TAB LEXAMIL 5MG TAB MACLEODS ESCITALOPRAM 10 MACLEODS ESCITALOPRAM 20 MARPREM 10MG TAB MARPREM 20MG TAB MARPREM 5MG TAB MYLAN ESCITALOPRAM 10MG NEXITO 10MG TAB ZITOLEX 10MG TAB ZITOLEX 20MG TAB ZYDUS ESCITALOPRAM 10MG T ZYTOMIL 10MG TAB ZYTOMIL 20MG TAB F FLUOXETINE A-LENN FLUOXETINE 20MG DEPROZAN CAP FLUOXETINE ACTOR 20MG CAP LILLY-FLUOXETINE 20MG LORIEN 20MG CAP LORIEN 20MG TAB NUZAK 20MG CAP PROHEXAL 20MG CAP PROHEXAL 20T PROHEXAL 40T PROLAX 20MG CAP PROZAC 20MG CAP PROZAC 20MG TAB RANFLOCS 20 REZAK 20MG CAP SANDOZ FLUOXETINE 20MG TRIZAC 20MG CAP ZYDUS-FLUOXETINE 20MG 4
5 FLUPENTHIXOL FLUANXOL DEP 20MG/1ML INJ FLUPHENAZINE MODECATE 25MG INJ 10ML MODECATE 25MG INJ 1ML MODECATE+SYRIN 25MG INJ H HALOPERIDOL SANDOZ HALOPERIDOL 1.5MG I IMIPRAMINE L LITHIUM M MIANSERIN MOCLOBENIDE SANDOZ HALOPERIDOL 5MG SERENACE 0.5MG CAP SERENACE 10MG TAB SERENACE 5MG TAB ETHIPRAMINE 10MG TAB ETHIPRAMINE 25MG TAB TOFRANIL 10MG TAB TOFRANIL 25MG TAB CAMCOLIT 250MG TAB CAMCOLIT 400MG TAB QUILONUM RET 450MG TAB LANTAN 10MG TAB LANTAN 30MG TAB AURORIX 150MG TAB AURORIX 300MG TAB CLORIX 300MG TAB 5
6 DEPNIL 150MG TAB DEPNIL 300MG TAB O OLANZAPINE ADCO OLANZAPINE 10MG TAB ADCO OLANZAPINE 2.5MG TAB ADCO OLANZAPINE 5MG TAB LANAZYP 10MG TAB LANAZYP 2.5MG TAB LANAZYP 5MG TAB MYLAN OLANZAPINE 10MG MYLAN OLANZAPINE 2.5MG MYLAN OLANZAPINE 5MG OLAWIN 10MG TAB OLAWIN 2.5MG TAB OLAWIN 5MG TAB OLAWIN 10MG ORADISPERSIB OLAWIN 5MG ORADISPERSIB OLAWIN 10MG ORADISPERSIB OLAWIN 5MG ORADISPERSIB OLEANZ 10MG TAB OLEANZ 2.5MG TAB OLEANZ 5MG TAB OLEANZ RAPITAB 10MG TAB KIZOFRIN 200MG TAB KIZOFRIN 25MG TAB MYLAN QUETIAPINE 25MG MYLAN QUETIAPINE 100MG MYLAN QUETIAPINE 200MG MYLAN QUETIAPINE 300MG QUETOSER 25MG TAB QUETOSER 100MG TAB QUETOSER 200MG TAB QUETOSER 300MG TAB 6
7 SEREZ 25MG TAB SEREZ 100MG TAB SEREZ 200MG TAB SEREZ 300MG TAB SEROQUEL 100MG SEROQUEL 200MG SEROQUEL 25MG SEROQUEL 300MG SEROQUEL XR 50MG SRT SEROQUEL XR 150MG SRT SEROQUEL XR 200MG SRT SEROQUEL XR 300MG SRT SEROQUEL XR 400MG SRT SIZORM 100MG TAB SIZORM 200MG TAB SIZORM 25MG TAB SIZORM 300MG TAB TRUVALIN 25MG TAB TRUVALIN 100MG TAB TRUVALIN 200MG TAB TRUVALIN 300MG TAB R RISPERIDONE ASPEN RISPERIDONE 0.5MG ASPEN RISPERIDONE 1MG ASPEN RISPERIDONE 2MG ASPEN RISPERIDONE 3MG ASPEN RISPERIDONE 4MG AUROPERDAL 0.5MG TAB AUROPERDAL 1MG TAB AUROPERDAL 2MG TAB AUROPERDAL 3MG TAB AUROPERDAL 4MG TAB DRL RISPERIDONE 0.5MG TAB DRL RISPERIDONE 1MG TAB DRL RISPERIDONE 2MG TAB 7
8 DRL RISPERIDONE 3MG TAB MYLAN RISPERIDONE 0.5MG MYLAN RISPERIDONE 1MG MYLAN RISPERIDONE 2MG PERIDA 0.5MG TAB PERIDA 1MG TAB PERIZAL 0.5MG TAB PERIZAL 1MG TAB PERIZAL 2MG TAB PERIZAL 3MG TAB RISNIA 0.5MG TAB RISNIA 1MG TAB RISNIA 2MG TAB RISNIA 3MG TAB RISPACOR 0.5MG TAB RISPACOR 1MG TAB RISPACOR 2MG TAB RISPACOR 3MG TAB RISPACOR 4MG TAB RISPERDAL 0.5MG TAB RISPERDAL 1MG TAB RISPERDAL 2MG TAB RISPERDAL 3MG TAB RISPERDAL 4MG TAB RISPERDAL QUICKLET 0.5MG RISPERDAL QUICKLET 1MG RISPERDAL QUICKLET 2MG RISPERDAL QUICKLET 3MG RISPERIDONE HEXAL 0.5MG RISPERIDONE HEXAL 1MG TAB RISPERIDONE HEXAL 2MG TAB RISPERIDONE HEXAL 3MG TAB RISPERLET 0.5MG TAB RISPERLET 1MG TAB RISPERLET 2MG TAB 8
9 RISPEVON 1MG TAB RISPEVON 2MG TAB RISPEVON 3MG TAB RISPEVON 4MG TAB RISPONZ 1MG TAB RISPONZ 2MG TAB RISPONZ 3MG TAB RISPONZ 4MG TAB SCHIZOROL 0.5MG TAB SCHIZOROL 1MG TAB SCHIZOROL 2MG TAB ZOXADON 0.5MG ZOXADON 1MG ZOXADON 2MG T TRANYLCYPROMINE PARNATE 10MG TAB TRIFLUOPERAZINE STELAZINE 1MG TAB STELAZINE 5MG TAB Z ZUCLOPENTHIXOL CLOPIXOL 2MG TAB CLOPIXOL 10MG TAB CLOPIXOL DEPOT 200MG INJ 9
YES = formulary NO = non-formulary NO BENEFIT = excluded. Beat4 Beat1 Beat 3 Pace2 Beat2 Pace1 Pace3 Pace4 A NO BENEFIT SANDOZ AMITRIPTYLINE 25
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